Mental health and serious mental
IN 2001, APPROXIMATELY 15 million Americans aged 18 or older were estimated to have a serious mental illness (SMI; SAMHSA, 2002). Persons with serious mental illness (SMI) are individuals whose emotional or behavioral functioning is so impaired that they cannot remain in the community without supportive treatment. Their mental impairment is both severe and persistent and limits capacities for primary activities of daily living, interpersonal relationships, homemaking, self-care, employment, and recreation. When individuals with serious mental illness are discharged to the community, continuous care is both desirable and necessary ( Bachrach, 1981; Blank, Chang, Fox, Lawson, & Modlinski, 1996).
Treatments for persons with SMI include pharmacology as well psychoeducation and assertive community treatment. Medication nonadherence in the SMI population has been established as a risk factor for relapse (Grunebaum, Weiden, & Olfson, 2001), and improving medication adherence has been identified as a goal of community mental health (Heinssen, Lieberman, & Kopelowicz, 2000). Without contact with the mental health system after discharge, however, patients have few opportunities to receive and adhere to medication plans. In one study, patients who did not keep outpatient appointments showed rehospitalization rates, which increased over time, ranging from 15% to 29% greater than for those who kept outpatient appointments (Nelson, Maruish, & Axler, 2000).
Lack of continuity also places the individual at risk for becoming lost to further services (Farrell, Koch, & Blank, 1996). Although medication adherence is problematic in community mental health, psychoeducation approaches have been shown to make a difference in changing behavior (Chien, Kam, & Lee, 2001). The Surgeon General’s Report (U.S. Department of Health and Human Services, 1999. Mental Health: A report of the Surgeon General, U. S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, Rockville, MD.USDHHS, 1999), however, notes that these services are consistently unavailable in rural areas. Thus it is essential to expand the supply of effective, evidence-based services (Smith & Allison, 1998) and technology could be the tool of that dissemination. Technology offers solutions that are feasible if they are acceptable and usable in community mental health (Greenberg, 2000).
Portal technology is emerging as a web-based mechanism whereby users of a homepage can personalize both the look and the placement of links to specialized content. At the same time, the programmers behind the scene can customize the content to be pushed to the consumer. With this “push-pull” system, homepage portals can be designed to meet the individualized needs of the user.
Persons with SMI may have difficulty with technology, but some evaluations of computer use by psychiatric patients show that even those who are quite disturbed interact very successfully with computers, including patients who are unable to interact with mental health personnel.
A computer portal designed to offer a doorway into a world of information about mental health services and community resources offers promise for improving the lives of persons with serious mental illness living in the community. Psychiatric nurses, who serve as a bridge between hospital and community (Farrell, Koch, Blank, Munjas, & Clement, 1999), can be brokers of information for helping them to understand and use the internet ( Ferguson, 1997; Simpson, 1998).
The study reported here developed and evaluated individualized homepage web portals for use by hospital nurses, community case managers and consumers of community mental health services. The objective was to combine the technology of web portals with content appropriate for community mental health. The web pages were prepared so that they could be available using internet technology and personal computers in clinics, public libraries, and anywhere with internet access.
The long-term goals of the mental health portals are to improve adherence to treatment plans (eg, keeping appointments, keeping housing), improve adherence to medication regimens, and increase satisfaction with care for persons with serious mental illness receiving case management in community mental health agencies.
Methods
The research team conducted two initial studies to help develop a first draft of the portal. These studies examined provider perceptions of the portal through the use of focus groups at three Mental Health Clinics and consumer perceptions through the use of interviews with a sample of 20 members of Clubhouse, a psychosocial rehabilitation program. From the results of these preliminary studies (Farrell, Mahone, Packer, & Southall, 2004), the initial web portal was developed.
Setting
The setting was an inpatient unit of Western State Hospital (WSH), one of the state facilities licensed and operated by the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services. This comprehensive state mental health system is connected to a large tertiary care health system where persons with serious mental illness receive case management, medication support, and psychosocial rehabilitation. WSH is committed to developing and providing continuity of care for the citizens of Virginia with serious mental or substance abuse disorders within an integrated service system that includes linkages with consumers, families, and community health care providers.
Tags: serious mental